Boston Sports Medicine and Performance Group, LLC Blog

Integrated Care - Part I: The Language Barrier

Posted by Boston Sports Medicine and Performance Group on Mon, Aug 22, 2011 @ 07:08 AM

by Art Horne


Over the past several years I have made the integration of Sports Medicine care and Strength Training a core principle within our department.  This is relatively a new concept as strength coaches and sports medicine professionals have often been pitted against each other by sport coaches, athletes and often themselves.  Although this new path to better health and performance is clearly thwart with challenges, there are some simple steps that both departments can make that immediately impacts BOTH the health and performance of the student-athlete and leaves both professionals looking better in the eyes of all those around them.  Below is a question from a colleague that I wanted to share publicly.  In order to answer his question, as well as many others, it is my intention over the next few months to describe and share with you the many small steps that any college or university can implement in order to provide an improved care and performance model.


I would like to start out by saying that I really enjoy watching the videos and articles that you have released in reference to the approach you use at Northeastern University to bridge the gap between strength and conditioning and sports medicine. I am a strength and conditioning coach for a small Div. I college and also have a background in athletic training. I wanted to see if you could provide more insight as to how you take the results from the screening and testing that you do and then implement them into your programming. We screen our athletes, which consist of the FMS and a couple more orthopedic screens that we feel are applicable to the particular sport (Modified Thomas Test, Bridge w/ Leg Extension, Reach/Roll/Lift, etc….). How would you then use the results in the development of your program? Do you give each athlete individual work or do you use a systematic team approach addressing common faults or dysfunctions? I am torn as to what to do because as I am sure you are familiar with, time I have to spend with athletes is limited and getting them to comply with performing certain exercises on their own time can be very difficult at times. Any advice or examples that you could provide would be very beneficial. Thanks in advance for your time.

The Language Barrier:



The first step in any “relationship” is being able to understand what the other person is saying, and there is no greater communication gap in existence than the one that currently exists between Sport Medicine and Strength Training professionals.  In order to discuss dysfunctional movement patterns, corrective exercises, rehabilitation goals or substitutions/alternatives for strength exercises both parties must share a common language and then demand continuity with these terms.

I remember many years ago speaking to one of our staff members about a particular athlete and suggesting that she speak to the strength staff about an alternative exercise for an athlete who was suffering from some low back pain.  When asked what I recommended I immediately suggested a more spine sparing approach to her current “core strengthening” exercises and that we recommend McGill’s “Birddog” exercise which has been proven to be safer on the spine than the flexion based crunches the athlete was accustomed to in the weight room.  Not knowing what a “Birddog” exercise was, I quickly demonstrated the exercise to my co-worker at which time she smiled and said that she was familiar with the exercise but learned it as a kneeling opposite arm-leg reach.   Confused, (since McGill made the exercise famous as part of his “Big Three”) I asked another staff member what the exercise was that I was performing to which he replied, “a quadruped contralateral reach.”  Now slightly irritated (but happy that the name at least described the movement), I bolted over to the strength room to inquire about their knowledge of Stuart McGill, his research and what they called this particular exercise.  To my surprise McGill’s work had never been heard of and that this particular exercise was programmed as a “Flying Superman” within the student-athletes performance training.  It became painfully clear that the first order of business was getting both staffs to speak the same language, both within each department and across them. 

Because most of the members on your staff (both Sports Medicine and Strength) have come from a variety of educational backgrounds, continuing education courses and levels of expertise, it is important to begin formulating a shared exercise and assessment language in order for civil conversations to first take place.  By investing only a small amount of time and addressing this often overlooked, yet integral first step your staff will begin to enjoy the following benefits:

1. Provide improved services to your student-athletes.  Imagine the previous example taking place and a student-athlete approaching you for help with their kneeling opposite arm-leg reaches.  Now, the name basically tells you exactly what is needed, but imagine you knowing the exercise as a different name and perhaps emphasizing a different teaching point altogether.  Would you teach the athlete how to do the exercise “your” way? Find the athletic trainer who wrote the rehabilitation program to help them out? Or tell them that you’re sorry but you don’t know what they should be doing?  In any case precious time is wasted and as a fellow athletic trainer, this is something none of us has enough of.  In addition, you can imagine the frustration of the student-athlete witnessing your staff stumble through the most basic exercise descriptions!

2. A shared language allows staff members to be interchangeable because now each staff member is calling the same exercise the same name and teaching it while emphasising the same teaching points.  This allows athletic trainers to jump in and help with all rehabilitation programs, and not just “their own teams” as well as provide continued care during an athletic trainer’s absence (sick day, vacation or travel with another team).

3. Continued care and coaching along the performance continuum.   Here’s where the magic happens: whether the athlete your provide care for is one week into their ACL rehabilitation or the starting point guard for the basketball team pushing 300 pounds in the squat rack, the exercises if named the same, taught the same and progressed the same all fall along the same care-performance continuum.    Let’s examine the above example to really understand the power of the shared language.  Imagine on the far left hand side the student-athlete one week post-op ACL reconstruction and on the far right side the starting point guard pushing serious weight and performing at the highest level.  Moving along the continuum from left to right the athlete will experience and undergo exercises such as: Quad Sets, Straight leg Raises, Clams, Glute-Bridges, Mini-Band walks, Wall Squats, Body weight squats, Lunges, Box Jumps, and the list goes on.  At some time this athlete will be in the weight room and not be able to perform the Olympic lift for example programmed for the team that day but can certainly do pull-ups, side bridges and a number of other exercises that the strength coach has put in place during any particular phase or block of training.  If a shared language exists, the athletic trainer and the strength coach can have a civil and meaningful conversation about where the athlete is and discuss and implement substitutions for exercises that are not appropriate for them all while progressing the athlete safely along this care-performance line.  Not to mention, many of the rehabilitation exercises can be implemented safely within strength training program as substitutions for advanced exercises thus minimizing the athlete’s daily rehabilitation time and allowing the athletic trainer who is providing care for this athlete more time to focus on other athletes or say for example address soft tissue restrictions with the same athlete during “rehab” time which often requires a one-on-one time period, thus making their strength training time much more effective.

Now, some people may say that a couple of exercise names or switching names from time to time is really not a big deal.  Perhaps not.  If you only care for one team, perform all the rehabilitation by yourself and no other staff member helps you, then you can certainly come up with your own language.  But imagine for a moment a car factory where all the parts are all called different names, put on in different orders and actually assembled with various degrees of precision.  Would you ever buy a car from a factory like this?  The answer is a resounding no - so how can we expect our student-athletes to buy in to what we are saying if each staff member is saying something different?  By having an Exercise Pool to draw consistent language from, the number of benefits far outweigh any possible downside while also reducing the amount of confusion among your own staff and encouraging an atmosphere of shared help and patient responsibility. 

Next week: How a shared language during initial assessment can limit overall injury rate and increase performance immediately.

Topics: Art Horne, basketball performance, basketball training programs, BSMPG, athletic training conference, Barefoot in Boston, barefoot running, barefoot training

Barefoot In Boston now available on Kindle

Posted by Boston Sports Medicine and Performance Group on Wed, Aug 10, 2011 @ 16:08 PM


barefoot in boston

You know those fancy, air-filled, arch-cushioned, expensive-as-hell sneakers that you buy to enhance your performance? Well, what if we told you they were most likely not only decreasing your performance, but increasing your likelihood of injury? You would probably call us crazy, but people thought Galileo was crazy once too.  Are we comparing ourselves to Galileo? No, great guy though.  What we are saying is that we are proponents of an idea which is growing in popularity and for some very good reasons.  Barefoot training has recently become popularized as a potential benefit in injury rehabilitation programs. It is also purported to serve as an additional means of injury prevention and to enhance athletic performance.  However, limited clinical research is currently available to justify this practice and even less information is available describing how one may go about safely implementing a barefoot training program.  This book explores the scientific and theoretical benefits concerning the merits of barefoot training and offers real life solutions and alternatives to all the things separating you and your feet from mother earth, including examples of specific programs and training progressions.  By the time you are through with this book, you will be part of the movement and your feet will be on their way to a happier, healthier version of their formerly miserable selves.

Topics: reduce injury risk, foot pain, foot fracture, barefoot strength training, Barefoot in Boston, achilles pain, barefoot running, barefoot training

Sorry, Store Policy

Posted by Boston Sports Medicine and Performance Group on Thu, Jul 28, 2011 @ 07:07 AM

athletic training


While taking a walk on vacation last summer with my fiancée, we stopped outside of a boutique when a dress caught her attention.  In town for a wedding the very next day along with a brisk change in weather, she decided that the dress in the window would work perfectly for the occasion.

Upon entering the store at 10:50 am we were quickly met by a sales person who promptly told us that they didn’t open until 11:00 am and that we’d have to wait outside until that time.

“But I’m going to buy that dress in the window – I just love it.  Can I just look?” She said.

“Sorry, You will have to wait outside - Store policy.”

And with those words the store door closed behind us while the three customer services reps inside read the paper, drank their espressos and chatted.  With the bitter taste of the rep’s reception fresh in my mouth we walked next door and dropped $200 on a similar dress.

What store policy doesn’t allow a customer to look at a product that they are obviously willing to purchase?

Would that policy have existed if the store owner was standing nearby?

It’s not that this store had a “policy” that didn’t allow customers inside until they were open that caused my blood pressure to rise, it was the fact that the customer service representative didn’t represent me, the customer.

So maybe you can’t open the cash register until 11, and maybe you really can’t allow anyone inside – but if you’re looking to make me a customer in the long run, you better at least sell me on the short term.

The challenge for many health care providers is that we too have policies that must be followed.  And maybe you aren’t able to care for the kid that walks in for treatment 10 minutes before you close, but knowing that there is a huge difference between telling them “sorry come back tomorrow” and “let me schedule you a time tomorrow where I can dedicate the time you deserve,” means the difference between that customer returning a day later and that same customer seeking services elsewhere.

Topics: Art Horne, basketball training programs, athletic training conference, barefoot running

A Bigger Box

Posted by Boston Sports Medicine and Performance Group on Mon, Apr 5, 2010 @ 09:04 AM

I hate when people say, “You need to think outside the box,” like they’ve just discovered the world was round.

Since when was reading articles or attending conferences “thinking outside the box”?  When did practicing evidence-based medicine or implementing strength programming other than 3 sets of 10 on bench press every Monday become novel thinking?

Some people just need to get a bigger box.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at


Register for the May 2010 Basketball and Hockey Conference!


Topics: Strength Training, basketball conference, athletic training conference, boston hockey summit, boston hockey conference, Mike Boyle, barefoot running, mental toughness, northeastern

Putting Your Best Foot Forward

Posted by Boston Sports Medicine and Performance Group on Mon, Mar 22, 2010 @ 21:03 PM

Regardless of which side of the “barefoot” fence you sit, recent scientific developments by Harvard professor and barefoot enthusiast, Dr. Daniel Lieberman is sure to have you thinking about whether you should be reaching for your high top sneakers prior to your next stroll around the neighborhood or forgoing them all together in place of nature’s offering.  For those that continue to debate that running barefoot is just not feasible and perhaps dangerous, I’d have to offer a rebuttal…. I mean, barefoot running and training doesn’t mean going on an eight hour run looking for your next meal.  Unfortunately, the term “barefoot training” has been hijacked and equated with burning your shoes followed by a life of hugging trees and growing your hair out.  I mean, we’ve all tried to increase our bench press max right? But we didn’t start day one with 350 lbs on the bar.  Like everything else, the decision of how to and when to go barefoot is dependent on a number of factors, but is certainly governed by the law of progressive overload and common sense.  Several practical suggestions on how to implement some barefoot work into your team’s training can be found in the March issue of Training and Conditioning.  I’m not advocating you send your starting basketball center who’s been wearing Nike shocks their whole life for a run and plyo workout, but I’m pretty sure they have had shoes off recently, (maybe as recent as this morning when they woke up and walked to the bathroom) and their foot didn’t break right? So why don’t we take advantage of Mr. Wolff’s law and challenge your foot, ankle, and lower extremity just a little bit.  
Barefoot training won’t cure cancer but it just might put a smile on your feet again.

For a cliff note version of Dr. Lieberman’s Harvard work click here.

Art Horne Is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at


Click here to register for the 2010 conference in May!

BSMPG  Discount ends soon!!

Topics: basketball conference, athletic training conference, boston hockey summit, boston hockey conference, sports performance, barefoot running, barefoot training, nike free